All About Nursing · Hospice & Palliative Care

“NURSE” -the American Association of Critical Care Nurse’s Therapeutic Communication Tool

The American Association of Critical Care Nurse’s therapeutic communication tool “NURSE” is an empathy tool when having emotional conversations to help guide the conversation to convey empathy and to elicit more information:

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Kubler-Ross Model – The 5 Stages of Grieving

Elisabeth Kubler-Ross Model describes five stages in which the dying patient moves through denial, anger, bargaining, depression, and acceptance.

The first stage of the process of grieving and preparing for death is denial. This may initially manifest as shock or speechlessness. It is common to believe a mistake in the prognosis has been made due to inaccurate test results, having not attempted the correct treatment, or deficits in knowledge of their provider.

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All About Nursing · Hospice & Palliative Care

Complicated Grief – the feelings after a loss of the loved one

Complicated grief is when the feelings of loss are debilitating and do not improve after a long amount of time passes. There is no set amount of time that one moves through the stages of grief; however, there is general movement toward growth and healing in a normal grief experience. A generally accepted amount of time is one year. In complicated grief, the painful emotions are so consuming that the individual has trouble recovering from the loss to resume their life. In the beginning months after a loss, normal grief and complicated grief appear very similar; however, complicated grief will likely worsen instead of gradually fade.

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Hospice – Eligibility (Reading & Sharing)

Hospice is an all-encompassing service available for patients with a prognosis under 6 months. Under the Medicare hospice benefit, patients eligible for hospice are greater than 65 years or receiving Medicare disability payments. At the start of care, two physicians must sign a statement certifying that the patient’s life expectancy is six months or less based on their best estimate of the patient’s medical prognosis. While hospice benefit was originally designed for Medicare recipients, most insurance providers cover hospice care for patients not eligible for Medicare. But, hospice eligibility depends on more than only a physician determining a prognosis of six months o less until death.

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Mechanical Ventilation (Reading & Sharing)

The clinical applications of ventilation and the use of specific modes during the acute stage of illness focus on protecting the lung and improving the patient outcomes.

Acute respiratory distress syndrome (ARDS), the most severe presentation of acute lung injury, results from an acute insult to the body that may be direct or indirect (pneumonia vs sepsis). The release of mediators and a host of other toxic substances affect the alveolar- capillary permeability adversely and result in a noncardiac pulmonary edema. Pathology includes decreased compliance, shunting, and refractory hypoxemia. No definitive treatment, but the therapy focus on managing the underlying condition and on supportive mechanical ventilation.

The two most common types of ventilations:

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